Delayed Puberty

Puberty begins when the hypothalamic-pituitary-gonadal (HPG) axis becomes active. Hypothalamic signalling stimulates the pituitary, pituitary hormones stimulate the gonads, and the gonads produce sex steroids that drive growth and secondary sexual characteristics. Delayed puberty occurs when this sequence has not begun or is insufficiently active for the expected developmental stage. The outward pattern may look similar even when the cause is different: - Constitutional or familial delay is a variation in the timing of maturation. A family history of late puberty and delayed bone age may support this pattern. Once this explanation is established, reassurance and observation are usually appropriate. - Functional hypogonadotropic hypogonadism reflects reduced central stimulation of the gonads. The problem is upstream in the hypothalamic-pituitary signalling pathway and may be functional rather than permanent. - Permanent central failure means the hypothalamus or pituitary does not provide adequate stimulation. - Primary gonadal failure means the gonads cannot produce the expected response despite the central signal. The distinction matters because reassurance is appropriate only after an assessment has made constitutional delay reasonably likely. A nurse should not dismiss absent...